Healthcare Provider Details

I. General information

NPI: 1134323561
Provider Name (Legal Business Name): S AND S KIM GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W HORIZON RIDGE PKWY STE 140
HENDERSON NV
89012-4896
US

IV. Provider business mailing address

1450 W HORIZON RIDGE PKWY STE B305 # 570
HENDERSON NV
89012-4480
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-5445
  • Fax: 702-566-5035
Mailing address:
  • Phone: 702-566-5445
  • Fax: 702-448-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUNGWOOK S KIM
Title or Position: PRESIDENT
Credential: MD
Phone: 702-566-5445